Endoscopy is a minimally invasive surgical procedure and includes, among other procedures, laparoscopy, thoracoscopy, and arthroscopy. Endoscopic procedures involve viewing the interior of the body using an illuminated optical instrument, referred to as an endoscope. The endoscope and other surgical instruments for operating on tissue inside the body enter the body through ports placed in small incisions in the skin.
Endoscopic procedures are typically conducted using specialized surgical instruments that have been adapted to perform general surgical procedures endoscopically. Endoscopic surgical instrument end effectors often take the form of a scissors, dissectors, or scissoring jaws, attached to the distal end of a rigid shaft. A handle attached to the proximal end of the shaft has a mechanism for operating the end effector. An operating linkage inside the shaft connects the handle to the end effector. The handle may also have a second mechanism for rotating the shaft and end effector.
Suturing is the preferred method of tissue approximation in endoscopic procedures. Suture needles are typically curvilinear in shape to facilitate stitching. One end of a suture needle is sharpened, and suture thread is attached to the other end of the needle. Because of restrictions on space and on instrument orientation, suture placement and tying of the suture thread involve difficult and awkward movements, making the process of suturing both lengthy and tedious. Surgical needle holders and needle drivers designed for endoscopic procedures generally have taken the form of an elongated tool designed to hold the suture needle rigidly and immovably in the surgical instrument. These holders and drivers enable the surgeon to hold and push the needle through tissue, but do not give the surgeon good needle mobility.
While the holders or drivers are typically comprised of a pair of jaws, they can take other forms, such as a gripper and anvil. A needle is typically grasped by the jaws midway between the tip of the needle and its tail. When a needle is first grasped in the jaws of a traditional needle holder, the needle may curve in any direction, whether upward, downward, distally, or proximally. In practice, the surgeon uses a second instrument, such as a forceps, a dissector, or another needle holder, to grasp and help orient the needle before suturing. This practice can be awkward and slow, and can also result in errors.
As surgeons become more proficient in conducting minimally invasive surgery, they are attempting to conduct more difficult and complex procedures laparoscopically. These newer procedures often require accurate suture placement. Present laparoscopic needle holders hold the needle firmly, but do not allow the operator to reorient the needle easily. In open surgery, where access is not restricted, this is not a problem. However, where access becomes restricted, such as in endoscopic procedures, needle re-orientation by the needle holder becomes more important.